The practicality of EMT Basics as an emergecy responder

[NomadicMedic]

Most areas that I've seen require that BLS transport to the closest available receiving center, regardless of any specialty considerations. Also, good information gathering? So... how's your neuro exam?

In looking at protocols for many different services, I see that the changes to mandate transport to a specialty center are being made. It seems as though medical directors are finally realizing that even BLS people can take stroke patients to stroke centers and chest pain patients to centers that have PCI capability

 

[Brandon O]

Most areas that I've seen require that BLS transport to the closest available receiving center, regardless of any specialty considerations.

Mass permits it, although just about everywhere is a stroke center anyway.

information gathering? So... how's your neuro exam?

Pretty good. Need to work on my DTRs and Babinski, as well as operationalizing my cerebellar function tests. How's your hemorrhoids?

 

[NYMedic828]

Mass permits it, although just about everywhere is a stroke center anyway.



Pretty good. Need to work on my DTRs and Babinski, as well as operationalizing my cerebellar function tests. How's your hemorrhoids?

Careful, he may be your boss one day.

If I was working with someone and they began performing DTR evaluations/babinksi I would probably look at them like they had a few extra heads. Mainly because I would be in awe that I had a partner who knew what either one was...

Also, lost me at hemorroids?

 

[medicsb]

The use of IV systemic tPA is simply an attempt of medical treatment of a surgical disease. Why would anyone be shocked when it doesn't work nor produce studies demonstrating benefit?

For this to be true, it would have to be a known and established surgical disease. Prior to tPA, the treatment for MI was largely placing the patient in a room, providing supportive treatment (e.g. morphine), and essentially praying that they don't die. Was the treatment of CVA any different prior to tPA? From what I can tell (skimming a few reviews of CVA management from the 70s) is that there was nothing to be done from a surgical standpoint and they were managed similarly to an MI (time and prayer). If a pharmacologic therapy were to be successful, would it still be a surgical disease? To declare it surgical and suggest that physicians have been ignoring the surgical nature is a bit Whiggish.

Clotting agents, IV tPA, you name it, the dream of nonsurgeons using medicine to treat surgical diseases is alive and well. It is folly. But people fund research for it and pay lots of money to try.

As if surgeons are jumping in to save the day from these crazy non-surgeons? Again, ischemic stroke was medical and not surgical. Just because surgeons found a way to manage the disease surgically, doesn't mean the previous physicians were fools for trying to manage them medically before surgery was ever an option.

 

[medicsb]

In looking at protocols for many different services, I see that the changes to mandate transport to a specialty center are being made. It seems as though medical directors are finally realizing that even BLS people can take stroke patients to stroke centers and chest pain patients to centers that have PCI capability

One day they might realize that CVA sans airway or hemodynamic problems is a "BLS" emergency and eliminate obligate ALS dispatches. There's no reason a non-medic can't call a stroke alert.

 

[Brandon O]

If I was working with someone and they began performing DTR evaluations/babinksi I would probably look at them like they had a few extra heads.

To me, this type of deeper assessment is mainly useful when a patient is considering a refusal, or otherwise appears intact but you'd like to look a bit deeper. But if JP says there are receiving staff who'll use it to trend symptom development, I'll buy that too.

Also, lost me at hemorroids?

You're such a charmer.

 

[JPINFV]

Also, lost me at hemorroids?

I'm assuming digital rectal exam.

 

[JPINFV]

To me, this type of deeper assessment is mainly useful when a patient is considering a refusal, or otherwise appears intact but you'd like to look a bit deeper. But if JP says there are receiving staff who'll use it to trend symptom development, I'll buy that too.

The question that's going to be answered is whether symptoms are improving or not. It's not that the ED and inpatient teams aren't going to be doing their own neuro exam, but if the inpatient team can go back another 30 minutes and get a trend that the patient is improving, then that can easily change the treatment decisions made.

 

[Jambi]

The question that's going to be answered is whether symptoms are improving or not. It's not that the ED and inpatient teams aren't going to be doing their own neuro exam, but if the inpatient team can go back another 30 minutes and get a trend that the patient is improving, then that can easily change the treatment decisions made.

How detailed does it need to be so that it useful? I've been using the "MEND" exam on my patients. No one knows what it is out here so I just document things individually.

http://www.asls.net/mend.html

 

[Veneficus]

For this to be true, it would have to be a known and established surgical disease.

Sepsis is a surgical disease... At least according to Fischer's Master of Surgery.

Prior to tPA, the treatment for MI was largely placing the patient in a room, providing supportive treatment (e.g. morphine), and essentially praying that they don't die. Was the treatment of CVA any different prior to tPA? From what I can tell (skimming a few reviews of CVA management from the 70s) is that there was nothing to be done from a surgical standpoint and they were managed similarly to an MI (time and prayer)..

That was part of my post...

However, with the recognition of the discipline of vascular surgery and its counterparts in interventional radiology and cardiology respectively, it seems to me obvious that the future the prefered treatment of vascular occlusion in any part of the body is going to be surgery for at least my lifetime.

In my mind, that makes it a surgical disease. (a disease primarily treated by surgeons) Whether the more medical minded people wish to concede that or not is really irrelevant.

Whether or not traditionally medical disciplines are performing vascular "procedures" it is still surgery. I renew my position that the lines drawn between medicine and surgery are for the convenience of practicioners, not as the best way to practice medicine.

Whether you are talking about vascular intervention, an ED, OB/Gyn, orthopedics, or even anesthesia, everyone has their surgical proedures. I highly suspect that as we refine which treatments work most of the time, there will be more of a merging between disciplines. I would say it is simply revolution. As not 100 years ago, there were not nearly the number of specialty disciplines there are today.

If a pharmacologic therapy were to be successful, would it still be a surgical disease?

I would say "no." But as i have explained and we have seen with PCI, at this point in time, medical treatment is not working.

To declare it surgical and suggest that physicians have been ignoring the surgical nature is a bit Whiggish

I was not trying to say that past physicians ignored the surgical nature of it. Obviously they did the best they had with the technology of the time. But I think it is important that we realize and admit the obviousness of the truth. In this age, it is vascular intervention which will most likely carry the day.

If you recall, in our career, community hospitals once without PCI used to find reasons and make guidlines for pharmacological treatment instead of immediately shipping the patient to a PCI lab. Still to this day we haven't globally mandated EMS take STEMI patients directly to a PCI center. (We do talk about it like it is best practice though)

I see this as more of the same only at the medicine level.

As if surgeons are jumping in to save the day from these crazy non-surgeons? Again, ischemic stroke was medical and not surgical. Just because surgeons found a way to manage the disease surgically, doesn't mean the previous physicians were fools for trying to manage them medically before surgery was ever an option.

I am not suggesting they were. But medicine or surgery are not the quickest to embrace change. Whether there is evidence or not.

 

[NYMedic828]

However, with the recognition of the discipline of vascular surgery and its counterparts in interventional radiology and cardiology respectively, it seems to me obvious that the future the prefered treatment of vascular occlusion in any part of the body is going to be surgery for at least my lifetime. .

Random question.

I know an ultrasound device can sometimes be used to break up a kidney stone. Why can't that same method be used in a cerebral pathology? (I imagine the distance the waves must travel and the structures they pass through come into play)

 

[RocketMedic]

As a guess, I'd reckon it's both the skull and that kidney stones are hard and resonate, while thrombuses are "soft" and don't break up as easily.

 

[JPINFV]

As a guess, I'd reckon it's both the skull and that kidney stones are hard and resonate, while thrombuses are "soft" and don't break up as easily.

Plus 1 clot vs multiple down stream clots since the clot is broken up instead of broken down.

 

[Handsome Robb]

Out of curiosity, using your logic... Since our entire State doesn't use aemt or emt-I, what does that say about them?

That medics in your state have to do a lot more since their EMT-B partner can't do a whole lot to help, procedure-wise, on acute patients, or even non-acute ALS patients.

That's what it means.

I'll take an EMT-I or AEMT over a basic as a partner any day of the week.

I'm not trying to be disrespectful but if you have 1 medic and 4 basics on a cardiac arrest that means the medic is not only having to gather information from the family but also control the airway, gain IV/IO access, draw and push meds and run the monitor all while directing the orchestra.

Whereas on arrests I stand back while my partner and our ILS FDs do all of the above while I manage the scene and don't get trapped doing skills. Sure antidysrhythmics are all me but other than that my partner and coresponders can do the rest while I focus on keeping everything moving in the right direction.

See my point?

 

[NYMedic828]

That medics in your state have to do a lot more since their EMT-B partner can't do a whole lot to help, procedure-wise, on acute patients, or even non-acute ALS patients.

That's what it means.

I'll take an EMT-I or AEMT over a basic as a partner any day of the week.

I'm not trying to be disrespectful but if you have 1 medic and 4 basics on a cardiac arrest that means the medic is not only having to gather information from the family but also control the airway, gain IV/IO access, draw and push meds and run the monitor all while directing the orchestra.

Whereas on arrests I stand back while my partner and our ILS FDs do all of the above while I manage the scene and don't get trapped doing skills. Sure antidysrhythmics are all me but other than that my partner and coresponders can do the rest while I focus on keeping everything moving in the right direction.

See my point?

Half agree, but not because your points are invalid.

Personally I would MUCH rather work with an EMT than a medic partner because 9/10 medics I work with are incompetent and miserable people. They don't want to be criticized or judged because they have it in their head that they are awesome and can do no wrong. It's a NYC attitude to begin with that is just exacerbated by the job.

It often hinders care because they find treatments like antiemetics and pain management to be a "waste of their time."

An EMT partner is more likely to listen to a person "above" them and use the criticism to improve because they assume that higher person to be correct (usually). An EMT working consistently with a medic also allows that EMT to progressively grow and learn. I would have no problem allowing an EMT partner to draw up meds, hang IVs and whatnot once I am comfortable with them.

If I could work with people on this forum id be a much happier individual.

 

[VFlutter]

If I could work with people on this forum id be a much happier individual.

I have accepted the fact that I am pretty much worthless as an EMT-B after being off the trucks for a year. I would be putting the KED on upside down and shoving LMAs in the wrong orifice :blink:

 

[Veneficus]

Plus 1 clot vs multiple down stream clots since the clot is broken up instead of broken down.

This without caveat or condition.

 

[TransportJockey]

That medics in your state have to do a lot more since their EMT-B partner can't do a whole lot to help, procedure-wise, on acute patients, or even non-acute ALS patients.

That's what it means.

I'll take an EMT-I or AEMT over a basic as a partner any day of the week.

I'm not trying to be disrespectful but if you have 1 medic and 4 basics on a cardiac arrest that means the medic is not only having to gather information from the family but also control the airway, gain IV/IO access, draw and push meds and run the monitor all while directing the orchestra.

Whereas on arrests I stand back while my partner and our ILS FDs do all of the above while I manage the scene and don't get trapped doing skills. Sure antidysrhythmics are all me but other than that my partner and coresponders can do the rest while I focus on keeping everything moving in the right direction.

See my point?

Granted I hate working wiht basics cause my workload gets doubles usually, but at least here a medic working a code wiht 2 basics and a couple first responders (if we're lucky, I've worked a two person (m/b) code before, that sucks), the basics can control airway with a combi or king, while I get access and run the code.

 

[DrParasite]

Granted I hate working wiht basics cause my workload gets doubles usually, but at least here a medic working a code wiht 2 basics and a couple first responders (if we're lucky, I've worked a two person (m/b) code before, that sucks), the basics can control airway with a combi or king, while I get access and run the code.

I hated working on a B/P crew. also hated working on a B/P/RN crew. I much rather preferred B/B and P/P (tiered system).

The reason was quite simple: on a B/P crew, the paramedic treats the sick patients, while the basic drives. All too often this results in the basic being absolutely clueless on what to do on a sick patient, because they always need the medic to hold their hand on what they do. If the patient is stable, the EMT does the stare of life, but they really don't get much experience with the sick people. Now if you are a good medic and you do teach your emt how to do things, why things are done, and you don't relegate them to carrying equipment and driving, than more power to you, but I think you are the rarity rather than the norm.

That's why when people on these forums talk about EMTs not knowing what to do when faced with a sick patient, or panicing and running around like a chicken with their head cut off, I have to ask how much experience do they really have dealing with sick people when they don't have a medic there to hold their hand.

btw, the only way I think a B/P system works is if you have a flycar P available for those big calls, calls that you need a second paramedic. cardiac arrests, major traumas, CPAP and RSI cases, sometimes you just need the second pair of skilled hands to assist in treating the patient properly. otherwise it's very easy to miss something, esp if you are trying to everything solo.

 

[gfb21t]

hey, can you fail the pa emt written test if you don't show up